Bipolar Medications

If you have bipolar
disorder, you’ll need to be treated on an ongoing basis. In fact, you should be
seeing a mental health professional regularly—a professional should always
monitor your condition, even if you feel fine. Treatment usually includes a
combination of medication and talk therapy.

Psychiatrists
typically recommend medications as initial treatment to control symptoms as
quickly as possible. Once symptoms are under control, maintenance treatment
follows. Maintenance treatment is very important; without it, the risk of
relapse is high. There is also a greater chance that minor mood swings can turn
into full-blown mania or depression.

Several
types of medications are used to treat bipolar disorder. These include mood
stabilizers, antidepressants, and drugs that relieve anxiety. Your doctor may
prescribe one or a combination of medications for maximum effect.

Finding
the right medication or combination of medications will take some trial and
error. You may need to change medications due to side effects. It can take up
to eight weeks to see the full effects of each medication. Usually, only one
medication is changed at a time—this enables your doctor to better monitor and
identify which one is not working.

Medications
to treat bipolar disorder include:

Lithium

Lithium
(such as Lithobid) is a mood-stabilizing drug that has been used since the
1970s. It helps control symptoms of acute mania and is effective at preventing
the recurrence of periods of mania and depression.

Common
side effects include weight gain and digestive issues. The drug can also affect
your thyroid and kidneys. Periodic blood tests are needed to monitor thyroid
and kidney health.

Lithium
is a category D drug that should be avoided in pregnancy if at all possible.
However, in some instances the benefits may outweigh potential risks.

Anticonvulsants

Anticonvulsants are
mood stabilizers used to treat bipolar disorder. They have been used since the
mid-1990s. In 2009, the drug asenapine was approved for treatment of bipolar
disorder. It is also used to treat those with mixed episodes (manic and
depressed at the same time). Anticonvulsant drugs include:

asenapine
(Saphris)

divalproex
sodium (Depakote)

lamotrigine
(Lamictal)

valproic
acid (Depakene)

Common side effects
of anticonvulsants include weight gain, drowsiness, and an inability to sit
still. Anticonvulsants are also associated with increased risk of suicidal thoughts
and behavior. Valproic acid is known to cause birth defects. Lamictal is known
to cause a rash that can be dangerous. Alert your doctor to any new rash that
develops while on Lamictal.

Antipsychotics

Antipsychotic drugs
are another treatment option. Some commonly prescribed are:

olanzapine
(Zyprexa)

risperidone
(Risperdal)

quetiapine
(Seroquel)

Common
side effects include weight gain, drowsiness, dry mouth, decreased libido, and
blurred vision. Antipsychotics may also affect memory and attention. They are
also known to cause involuntary facial or body movements.

Antidepressants

These
include serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine
reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and
tricyclics. Antidepressants can sometimes trigger manic episodes. If they are
prescribed it is often along with a mood stabilizer to control manic symptoms.

Here
are some of the more commonly prescribed antidepressants:

SNRIs

desvenlafaxine (Pristiq)

duloxetine (Cymbalta, Yentreve)

venlafaxine (Effexor)

citalopram (Celexa)

escitalopram (Lexapro)

fluoxetine (Prozac, Prozac Weekly)

paroxetine (Paxil, Paxil CR, Pexeva)

sertraline (Zoloft)

amitripyline

desipramine (Norpramin)

imipramine (Tofranil, Tofranil-PM)

nortriptyline (Pamelor)

monoamine oxidase inhibitors (MAOIs)

phenelzine (Nardil)

tranylcypromine (Parnate)

SSRIs

citalopram
(Celexa)

escitalopram
(Lexapro)

fluoxetine
(Prozac, Prozac Weekly)

paroxetine
(Paxil, Paxil CR, Pexeva)

sertraline
(Zoloft)

Tricyclics

amitripyline

desipramine
(Norpramin)

imipramine
(Tofranil, Tofranil-PM)

nortriptyline
(Pamelor)

monoamine
oxidase inhibitors (MAOIs)

phenelzine
(Nardil)

tranylcypromine
(Parnate)

MAOIs

In
general, MAOIs are rarely prescribed unless a patient has a poor response to
SNRIs or SSRIs. Common side effects include reduced sexual desire, sleep
disturbance, increased appetite, dry mouth, gastrointestinal troubles, and
menstrual problems.

When
taking an MAOI, it is important to avoid other medications and foods like wine
and cheese, which can cause a rare, dangerous condition known as serotonin
syndrome.

Benzodiazepines

These
are a group of medications with anxiety-relieving properties. Benzodiazepines
include:

alprazolam
(Xanax)

chlordiazepoxide
(Librium)

clonazepam
(Klonopin)

diazepam
(Valium)

lorazepam
(Ativan)

Side
effects can include drowsiness, reduced muscle coordination, and problems with
balance and memory. These medications should be used with caution due to the
risk of dependence.

Symbyax

This
medication combines fluoxetine and the antipsychotic olanzapine. Symbyax has
properties of both an antidepressant and a mood stabilizer. Side effects can
include increased appetite, sexual problems, drowsiness, fatigue, and dry
mouth. If your doctor prescribes this medicine, ask if separate prescriptions
for the two components are less expensive. There is nothing magic in using the
combination pill. It is simply a new formulation of two existing drugs.

Medications and Pregnancy

Some
medications, such as lithium and valproic acid, can increase your unborn baby’s
risk for birth defects. Certain medications may also lower the effectiveness of
birth control drugs. If you are using birth control to prevent pregnancy make
sure to discuss this with your doctor.

In
addition, if you are currently breast-feeding, talk to your doctor about your
medication. Some may
not be safe for your baby.

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